1. WE MOVE - Multiple System Atrophy Symptoms, complications and treatment of MSA.Category Health Conditions and Diseases multiple system atrophy......multiple system atrophy (MSA) is a neurodegenerative disease marked by a combinationof symptoms affecting movement, blood pressure, and other body functions http://www.wemove.org/msa.html

What is multiple system atrophy? Multiple system atrophy (MSA) is a neurodegenerative disease marked by a combination of symptoms affecting movement, blood pressure, and other body functions; hence the label "multiple system" atrophy. The cause of MSA is unknown. What are the various forms of MSA? Symptoms of MSA vary in distribution, onset and severity from person to person. Because of this, three different diseases were initially described to encompass this range of symptoms: Shy-Drager syndrome, striatonigral degeneration, and olivopontocerebellar atrophy. In Shy-Drager syndrome, the most prominent symptoms are those involving the autonomic system, the body system that regulates blood pressure, urinary function, and other functions not involving conscious control. Striatonigral degeneration causes parkinsonian symptoms such as slowed movements and rigidity , while olivopontocerebellar atrophy principally affects balance, coordination, and speech. These diseases are now considered forms of MSA. What are the symptoms of MSA?

2. Multiple System Atrophy Articel by Timothy C. Hain, MD Northwestern University Medical School, Chicago. http://www.neuro.nwu.edu/meded/MOVEMENT/msa.html

Multiple System Atrophy (MSA) Timothy C. Hain, MD Northwestern University Medical School, Chicago, USA Last update: 1/19/2001 This material is written primarily for medical students and neurology residents Please read our Multiple system atrophy is a rare neurological disorder characterized by a combination of parkinsonism, cerebellar and pyramidal signs, and autonomic dysfunction. The term "Multiple System Atrophy" is synonymous with striatonigral degeneration (SND) when Parkinsonism predominates, olivopontocerebellar atrophy (OPCA) when cerebellar signs predominate, and Shy-Drager syndrome when autonomic failure is dominant. The incidence (new case per 100,000 person years) for ages 50 to 99 years is 3.0 (Bower et al, 1997), or about half as frequent as progressive supranuclear palsy (PSP) . The mean age of onset is 54. The Parkinsonism of MSA is generally an akinetic rigid syndrome, similar to that of PSP . Rest tremor may occur but is not a predominant feature. Postural instability is common. Parkinsonism is generally the most common initial sign and eventually develops in about 90% of all patients. The cerebellar signs inlude finger-to-nose or heel-shin dysmetria, gait ataxia, intention tremor and nystagmus. Cerebellar signs are the first feature on only about 5% of patients. Cerebellar signs are observed in 50% of cases (Ben-Shlomo et al, 1997). Sporadic OPCA evolves into MSA in roughly 25% of cases within 5 years.

3. N.P.F. / The Parkinson Report Good Article on MSA by the National Parkinson Foundation.Category Health Conditions and Diseases multiple system atrophy......VOLUME XIX ISSUE 2 / Spring 1998. multiple system atrophy. By Between25,000 and 100,000 American have multiple system atrophy. However http://www.parkinson.org/atrophy.htm

VOLUME XIX - ISSUE 2 / Spring 1998 Multiple System Atrophy By members of the National Parkinson Foundation Center of Excellence at Vanderbilt University, including David A. Robertson, Director, Nathan S. Blaser Shy-Drager Research Laboratories; Thomas L. Davis, Director, Movement Disorder Clinic; and Ariel Y. Deutch, Director, NPF Center of Excellence A lthough the cause of idiopathic Parkinson’s disease is unknown, Parkinson’s disease is probably the best characterized of the neurodegenerative disorders. The loss of dopamine in the striatum is the major contributor to the disorder. However, there are several other neurodegenerative disorders involving several different systems in the brain, in which striatal dopamine loss is also found. Among these other neurodegenerative disorders is multiple system atrophy (MSA), in which degeneration in diverse brain regions leads to problems in the control of movement, balance, blood pressure, and sexual and urinary tract function. MSA is often accompanied by some striatal dopamine loss and in certain patients typical parkinsonian symptoms are either the first noted or the most prominent. A number of areas of the brain are involved by MSA. This has led to different varieties of MSA receiving different names, depending on which area of the brain has predominant involvement. When MSA begins with imbalance, incoordination, and difficulties in speaking (dysarthria), it is often called olivopontocerebellar atrophy; as the name suggests, this form of MSA is marked by degeneration in the cerebellum, a structure involved in balance and learned motor tasks. When a patient initially has rigidity (stiffness) and slowness in initiating movements (bradykinesia) that is out of proportion to tremor, this MSA form has been called striatonigral degeneration, involving communication between nerve cells in the striatum and midbrain. In patients in whom changes in autonomic function dominates the initial presentation, particularly changes in blood pressure regulation, the MSA form is often called Shy-Drager syndrome.

4. Autonomic Movement Disorders Program: Department Of Neurology Of Mount Sinai Sch multiple system atrophy multiple system atrophy is a neurological disorder that begins in adult life and is characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction in various combinations. Parkinsonism refers to slowness of http://www.mssm.edu/neurology/autodis/disorders/msa

Multiple system atrophy Multiple System Atrophy is a neurological disorder that begins in adult life and is characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction in various combinations. Cerebellar ataxia refers to impaired coordination and is caused by degeneration of the cerebellum. Autonomic dysfunction causes orthostatic hypotension (fall in blood pressure upon standing up) bladder and bowel dysfunction, and impotence. Literature on multiple system atrophy Multiple System Atrophy Hypertensive cardiovascular damage in patients with primary autonomic failure (note: Adobe acrobat is needed to read these files. You can download it here ... mssm home Questions? Contact the Web Development Office

5. Keynote Lecture KL5.2 In 1989 we were the first to describe glial cytoplasmic inclusions (GCI) in multiple system atrophy (MSA) (1). http://brainpathology.upmc.edu/vol7/0704/KL52.HTM

6. MSA called the "ShyDrager Syndrome" this complex syndrome is currently referred to as "multiple system atrophy" or MSA. http://www.ndrf.org/MSA.htm

NDRF National Dysautonomia Research Foundation 1407 W Fourth Street, Suite 160, Red Wing, MN 55066-2108 Phone: (651) 267-0525 Fax: (651) 267-0524 Be sure to visit the NDRF Reference Page where you can learn more about the NDRF Patient Handbook, Videos and other reference materials. Multiple System Atrophy In 1960, two researchers, Dr. Milton Shy at the National Institutes of Health, and Dr. Glen Drager at Baylor College of Medicine in Houston, Texas, described a common set of neurological manifestations associated with autonomic failure. Originally called the "Shy-Drager Syndrome" this complex syndrome is currently referred to as "Multiple System Atrophy" or MSA. The American Autonomic Society has defined MSA in the following manner: "MSA is a sporadic, progressive, adult onset disorder characterized by autonomic dysfunction, Parkinsonism, and ataxia (a failure of muscular coordination) in any combination. The features of the disorder include: Parkinsonism Cerebellar or Corticospinal Signs Orthostatic Hypotension, Impotence, Urinary Incontinence or Retention, usually preceding or within two years after the onset of the motor symptoms

7. Multiple System Atrophy FrontPage.Editor.Documenthttp//members.optushome.com.au/wwwombat December 17, 2002 - 13 KB7. eMedicine - multiple system atrophy Article by André Diedrich multiple system atrophy. Last Updated January 16, 2002 http://members.optushome.com.au/wwwombat

I have added a machine translation capability for some languages - click here for more information. ***Welcome*** The World Wide Wombat Multiple System Atrophy Web Site *** Most recent update on Patricia - 15 February 2003 *** PLEASE NOTE: I am transferring this web site to another domain - www.wwwombat.com - please update your bookmarks and/or favourites. This site will remain at its old domain until about the middle of April and will then only be available on the new domain. T his web site is dedicated to my wife Patricia who is in advanced stages of Multiple System Atrophy One of the objectives of this web site is to document what I know for others to read and contemplate. If I can assist someone out there, then this web site will have been worthwhile. Much of the information regarding Carer support and assistance is of most relevance to people living in Victoria, but I have no doubt that similar assistance is available in other States in Australia. For those people outside of Australia - it may provide you with some clues as to what might be available in your respective countries. In June 2002, I added a new page called "a personal perspective" and I encourage people to look at it objectively.

8. The Parkinson's Institute Movement Disorders Short article on clinical presentation and treatment.Category Health Conditions and Diseases multiple system atrophy......People with multiple system atrophy (MSA) can exhibit a wide variety of symptoms,including postural instability, slowed movements, muscle rigidity http://www.parkinsonsinstitute.org/movement_disorders/multiple_system.html

Treatment Center PD Dystonia ET ... TS People with Multiple System Atrophy (MSA) can exhibit a wide variety of symptoms, including: postural instability, slowed movements, muscle rigidity, orthostatic hypotension (a fall in blood pressure when standing), and urinary and sexual problems. As the term "multiple system atrophy" implies, MSA can vary in its affect on the nervous system, resulting in a range of symptoms. Thus, MSA is generally separated into three main categories depending on the predominant symptoms. Pharmacological treatment is much the same as Parkinson's disease, although as the disease progresses the benefits of these drugs diminish and often complicate the autonomic dysfunction, particularly orthostatic hypotension (low blood pressure). Orthostatic hypotension is often treated with fludrocortisone (Florinef ), midodrine (ProAmatine), or other drugs that raise blood pressure. Male impotence may be treated with penile implants or drugs. Incontinence may be treated with medications or catheterization. Constipation may improve with increased dietary fiber or laxatives. A speech-language pathologist may be able to offer strategies for improving swallowing and speaking. Use of softer foods may improve the ability to swallow. A gastrostomy tube, which delivers foods directly to the stomach, may be required at some time during the course of the disease. [return to top]

9. NINDS Shy-Drager Syndrome Information Page (multiple system atrophy)A look at this disorder, its treatment, prognosis, research and organizations. http://www.ninds.nih.gov/health_and_medical/disorders/shydrger_doc.htm

National Institute of Neurological Disorders and Stroke Accessible version Science for the Brain The nation's leading supporter of biomedical research on disorders of the brain and nervous system Browse all disorders Browse all health organizations More about Shy-Drager Syndrome Studies with patients Research literature Press releases Search NINDS... (help) Contact us My privacy NINDS is part of the National Institutes of Health NINDS Shy-Drager Syndrome Information Page Synonym(s): Multiple System Atrophy with Postural Hypotension Reviewed 07-01-2001 Get Web page suited for printing Email this to a friend or colleague Table of Contents (click to jump to sections) What is Shy-Drager Syndrome? Is there any treatment? What is the prognosis? What research is being done? ... Organizations What is Shy-Drager Syndrome? Is there any treatment? Orthostatic hypotension in Shy-Drager syndrome is treatable, but there is not known effective treatment for the progression central nervous system degeneration. The general treatment course is aimed at controlling symptoms. Antiparkinsonian medication, such as L-dopa, may be helpful. To relieve low blood pressure while standing, dietary increases of salt and fluid may be beneficial. Medications to elevate blood pressure, such as salt-retaining steroids, are often necessary, but they can cause side effects and should be carefully monitored by a physician. Alpha-adrenergic medications, non-steroidal anti-inflammatory drugs, and sympathomimetic amines are sometimes used. Sleeping in a head-up position at night reduces morning orthostatic hypotension. An artificial feeding tube or breathing tube may be surgically inserted for management of swallowing and breathing difficulties.

10. Arch Neurol -- Page Not Found The Combination of Hypointense and Hyperintense Signal Changes on T2Weighted Magnetic Resonance Imaging Sequences A Specific Marker of multiple system atrophy? http://archneur.ama-assn.org/issues/v56n2/abs/noc7612.html

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11. WE MOVE - Movement Disorders dystonia; Essential Tremor; Hereditary Spastic Paraplegia; Huntington'sDisease; multiple system atrophy (ShyDrager Syndrome); Myoclonus. http://www.wemove.org/mov.html

Voluntary movement is normally under the control of an individual. We will ourselves to move, walk across a room, sit in a chair, or simply sit still. For most of us, these decisions are automatic, and we take them for granted. But, for millions of people, these simple, everyday acts are frustratingly difficult, if not impossible. These people are living with neurologic movement disorders. Movement disorders can be classified into two basic categories: those characterized by disordered or excessive movement (termed "hyperkinesia" or " dyskinesia "), and those that are characterized by slowness, or a lack of movement (termed "hypokinesia," " bradykinesia ," or " akinesia "). An example of a "hyperkinetic" movement disorder is a tremor or a tic while Parkinson's disease can be classified as "hypokinetic," because it is often characterized by slow, deliberate movements, or even "freezing" in place. Neurologic Movement Disorders Include: Ataxia Corticobasal Degeneration Dyskinesias (Paroxysmal) Dystonia (general, segmental, focal)

12. Shy-Drager Syndrome multiple system atrophy with autonomic failure An article about this disorder giving an explanation, the types, treatment and prognosis. http://healthlink.mcw.edu/article/921961623.html

Search Articles: search tips Please Take the HealthLink Survey Email this article Print this article Find related articles: By topic: Neurology By keywords: Receive Health Link via email! Subscribe now >> Shy-Drager Syndrome Shy-Drager is often difficult totreat because of the fluctuations in blood pressure. The general treatment course is aimed at controlling symptoms. Anti-Parkinson medication, such as L-dopa, may be helpful but should be used with caution because it can lower blood pressure, causing blackouts. To relieve low blood pressure, dietary increases of salt and fluid may be beneficial. Medications to elevate blood pressure such as corticosteroids may cause side effects and should be carefully monitored by a physician. Alpha-adrenergic medications, metoclopramide, ergotamine derivatives, and indomethacin are useful in many cases. Sleeping in a head-up position at night may reduce headaches and morning dizziness. An artificial feeding tube or breathing tube may be surgically inserted for management of swallowing and breathing difficulties. In rare cases, a pacemaker may be implanted to correct heart irregularities. Shy-Drager usually ends in death 7 to 10 years after the onset of symptoms. Pneumonia is the most common cause of death, although irregularities in heart beat may be responsible for death in some patients.

13. National Parkinson Foundation, Inc. Progression and prognosis in multiple system atrophy An analysis of 230Japanese patients. Hirohisa Watanabe (lead author) 1 Department http://www.parkinson.org/msaprognosis.htm

Progression and prognosis in multiple system atrophy An analysis of 230 Japanese patients Hirohisa Watanabe (lead author) 1 Department of Neurology, Nagoya University, Nagoya, Japan E-mail: sobueg@tsuru.med.nagoya-u.ac.jp We investigated the disease progression and survival in 230 Japanese patients with multiple system atrophy (MSA) 131 men, 99 women 208 probable MSA, 22 definite MSA, mean age at onset, 55.4 years. Cerebellar dysfunction predominated in 155 patients, and parkinsonism in 75. Median intervals from onset to aid-requiring walking, confinement to a wheelchair, a bedridden state and death were 3, 5, 8 and 9 years, respectively. Patients showing combined motor and autonomic involvement within 3 years of onset had a significantly increased risk of not only developing advanced disease stage but also shorter survival. MSA-Parkinson patients had more rapid deterioration than MSA-Cerebellar patients but showed similar survival. Onset in older individuals showed increased risk of confinement to a wheelchair, bedridden state and death.

14. Multisystem Atrophy - Neurologychannel Good article on MSA including MSA anatomy.Category Health Conditions and Diseases multiple system atrophy...... Multisystem atrophy has three cardinal features Parkinsonism (see Parkinson’s); mostpatients do in fact have some sort of frontal system impairment and may http://www.neurologychannel.com/msa/

Home Search SiteMap Ask the Dr. ... Medical Store advertisement advertisement MULTISYSTEM ATROPHY Overview Anatomy of MSA Diagnosis Treatment CONDITIONS ADHD ALS Alzheimer's Disease Autism ... Carpal Tunnel Syndrome Cephalic Disorders Cerebral Palsy Charcot-Marie-Tooth Disease Dementia Encephalitis Epilepsy Essential Tremor ... Guillain-Barre Syndrome Headache Huntington's Disease Hydrocephalus Lou Gehrig's Disease ... Traumatic Brain Injury Vertigo TREATMENT OPTIONS Botulinum Toxin Therapy Epidural Injection Trigger Point Injection Vagus Nerve Stimulation RESOURCES Clinical Trials Links Videos ABOUT US Healthcommunities.com Pressroom Testimonial Overview Multisystem atrophy (MSA) is a group of rare, multisystem degenerative diseases that have several clinical features of Parkinson’s and are sometimes referred to as the "Parkinsonism-plus syndromes." When MSA was first identified in 1960 it was named "Shy-Drager Syndrome" after the two physicians who first described its symptoms. Now, Shy-Drager Syndrome is recognized as only one of three manifestations of multisystem atrophy. The other two are Striatonigral Degeneration and Olivopontocerebellar Atrophy (OPCA) . The three are lumped together as MSA because of their clinical overlap and neuroanatomical similiarities. Multisystem atrophy has three cardinal features: Parkinsonism (see Parkinson’s Autonomic failure (including orthostatic hypotension, erectile dysfunction, urinary incontinence or retention)

15. Multisystem Atrophy - Neurologychannel Good article on MSA including MSA anatomy. http://neurologychannel.com/msa/

Home Search SiteMap Ask the Dr. ... Medical Store advertisement advertisement MULTISYSTEM ATROPHY Overview Anatomy of MSA Diagnosis Treatment CONDITIONS ADHD ALS Alzheimer's Disease Autism ... Carpal Tunnel Syndrome Cephalic Disorders Cerebral Palsy Charcot-Marie-Tooth Disease Dementia Encephalitis Epilepsy Essential Tremor ... Guillain-Barre Syndrome Headache Huntington's Disease Hydrocephalus Lou Gehrig's Disease ... Traumatic Brain Injury Vertigo TREATMENT OPTIONS Botulinum Toxin Therapy Epidural Injection Trigger Point Injection Vagus Nerve Stimulation RESOURCES Clinical Trials Links Videos ABOUT US Healthcommunities.com Pressroom Testimonial Overview Multisystem atrophy (MSA) is a group of rare, multisystem degenerative diseases that have several clinical features of Parkinson’s and are sometimes referred to as the "Parkinsonism-plus syndromes." When MSA was first identified in 1960 it was named "Shy-Drager Syndrome" after the two physicians who first described its symptoms. Now, Shy-Drager Syndrome is recognized as only one of three manifestations of multisystem atrophy. The other two are Striatonigral Degeneration and Olivopontocerebellar Atrophy (OPCA) . The three are lumped together as MSA because of their clinical overlap and neuroanatomical similiarities. Multisystem atrophy has three cardinal features: Parkinsonism (see Parkinson’s Autonomic failure (including orthostatic hypotension, erectile dysfunction, urinary incontinence or retention)

16. EMedicine - Multiple System Atrophy : Article By André Diedrich multiple system atrophy The concept of multiple system atrophy (MSA) as a unitarydiagnosis encompassing several clinical syndromes has a long history (see http://www.emedicine.com/NEURO/topic671.htm

document.write(''); (advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Neurology Movement And Neurodegenerative Diseases Multiple System Atrophy Last Updated: January 16, 2002 Rate this Article Email to a Colleague AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: André Diedrich , Research Assistant Professor of Medicine, Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine Coauthor(s): David Robertson, MD , Director of Clinical Research, Professor, Departments of Internal Medicine, Pharmacology, and Neurology, Vanderbilt University André Diedrich, is a member of the following medical societies: American Autonomic Society , and American Heart Association Editor(s): Christopher C Luzzio, MD , Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison; Francisco Talavera, PharmD, PhD

17. Multiple System Atrophy Article By Horacio Kaufmann PDF article about MSA including MRI imaging. http://www.mssm.edu/neurology/autodis/disorders/msa/msapaper.pdf

18. PDF - Ask The Expert PD (3) Vitamins. Ask the Expert Search Category ParkinsonPlusShy-Drager Syndrome/multiple system atrophy, Question 408 (09/13 http://www.pdf.org/askexpert/index.cfm?category=59

19. MEDLINEplus Medical Encyclopedia: Multiple System Atrophy MEDLINEplus looks at this disorder and its symptoms, signs and tests, treatment and prevention.Category Health Conditions and Diseases ShyDrager Syndrome......multiple system atrophy. Causes, incidence, and risk factors Return totop. multiple system atrophy (MSA) is a rare degenerative condition. http://www.nlm.nih.gov/medlineplus/ency/article/000757.htm

Skip navigation Medical Encyclopedia Other encyclopedia topics: A-Ag Ah-Ap Aq-Az B-Bk ... Z Multiple system atrophy Contents of this page: Illustrations Alternative names Definition Causes, incidence, and risk factors ... Prevention Illustrations Central nervous system Alternative names Return to top Shy-Drager Syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome Definition Return to top A degenerative disorder characterized by progressive damage to the autonomic nervous system (the portion of the nervous system that controls involuntary functions such as blood pressure, heart rate, digestion and sexual function), muscle tremor and rigidity, slow movement, and other widespread neurologic losses. Causes, incidence, and risk factors Return to top Multiple system atrophy (MSA) is a rare degenerative condition. It is a condition that appears similar to Parkinson's disease in that patients may be slow moving, tremulous and have a shuffling gait but with more widespread neurologic damage and damage to the autonomic nervous system (the portion of the nervous system that controls involuntary functions). The cause is unknown. There is progressive damage (degeneration) of the nervous system, with damage to all parts of the nervous system. The disorder develops gradually. It is most often diagnosed in men over 60 years old.

20. Vanderbilt University Autonomic Dysfunction Center - Multiple System Atrophy Short article about MSA, including references and a ShyDrager Syndrome mail list.Category Health Conditions and Diseases multiple system atrophy......multiple system atrophy Introduction In multiple system atrophy, thereis widespread autonomic failure associated with impairment http://www.mc.vanderbilt.edu/gcrc/adc/msa.html

Overview History Faculty Research ... Patient Information Multiple System Atrophy Introduction: In multiple system atrophy, there is widespread autonomic failure associated with impairment in other neurological systems. The other neurological systems may be cerebellar, extrapyramidal, neuromuscular, or pyramidal. The pathological hallmark of MSA is neuronal loss and gliosis within multiple sites in the brain. Clinical Manifestations: The average age of onset is in the sixth decade of life. Men are affected twice as frequently as women are. In some patients, chronic glial cytoplasmic inclusion has been found to occur intracellularly in both glial cells and neurons of involved portions of the brain. This has been seen in patients carrying the clinical diagnosis of Shy-Drager syndrome, sporadic oligopontocerebellar atrophy, striatonigral degeneration, and corticobasal degeneration. These inclusions contain ubiquitin , but are quite distinct from Lewy bodies , which also contain ubiquitin. The glial cytoplasmic inclusions tend to be irregular in outline in contrast to the target-shaped concentric circular Lewy bodies. Some investigators have suggested a relationship between the Shy-Drager syndrome and Parkinson's disease, although this is not supported by the pathologic data accumulated to date.

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